Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Spine J. 2021 Feb;21(2):181-192. doi: 10.1016/j.spinee.2020.09.007. Epub 2020 Sep 22.
The introduction and integration of robot technology into modern spine surgery provides surgeons with millimeter accuracy for pedicle screw placement. Coupled with computer-based navigation platforms, robot-assisted spine surgery utilizes augmented reality to potentially improve the safety profile of instrumentation.
In this study, the authors seek to determine the safety and efficacy of robotic-assisted pedicle screw placement compared to conventional free-hand (FH) technique.
STUDY DESIGN/SETTING: We conducted a systematic review of the electronic databases using different MeSH terms from 1980 to 2020.
The present study measures pedicle screw accuracy, complication rates, proximal-facet joint violation, intraoperative radiation time, radiation dosage, and length of surgery.
A total of 1,525 patients (7,379 pedicle screws) from 19 studies with 777 patients (51.0% with 3,684 pedicle screws) in the robotic-assisted group were included. Perfect pedicle screw accuracy, as categorized by Gerztbein-Robbin Grade A, was significantly superior with robotic-assisted surgery compared to FH-technique (Odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.20-2.35; p=.003). Similarly, clinically acceptable pedicle screw accuracy (Grade A+B) was significantly higher with robotic-assisted surgery versus FH-technique (OR: 1.54, 95% CI: 1.01-2.37; p=.05). Furthermore, the complication rates and proximal-facet joint violation were 69% (OR: 0.31, 95% CI: 0.20-0.48; p<.00001) and 92% less likely (OR: 0.08, 95% CI: 0.03-0.20; p<.00001) with robotic-assisted surgery versus FH-group. Robotic-assisted pedicle screw implantation significantly reduced intraoperative radiation time (MD: -5.30, 95% CI: -6.83-3.76; p<.00001) and radiation dosage (MD: -3.70, 95% CI: -4.80-2.60; p<.00001) compared to the conventional FH-group. However, the length of surgery was significantly higher with robotic-assisted surgery (MD: 22.70, 95% CI: 6.57-38.83; p=.006) compared to the FH-group.
This meta-analysis corroborates the accuracy of robot-assisted pedicle screw placement.
机器人技术在现代脊柱外科中的引入和整合为医生提供了毫米级精度的椎弓根螺钉放置。结合基于计算机的导航平台，机器人辅助脊柱手术利用增强现实技术来提高器械的安全性。
本研究旨在确定与传统徒手（FH）技术相比，机器人辅助椎弓根螺钉放置的安全性和有效性。
研究设计/设置：我们使用不同的 MeSH 术语对 1980 年至 2020 年的电子数据库进行了系统回顾。
本研究测量椎弓根螺钉的准确性、并发症发生率、近侧关节突关节侵犯、术中放射时间、放射剂量和手术时间。
共纳入 19 项研究的 1525 例患者（7379 枚椎弓根螺钉），其中 777 例患者（机器人辅助组 51.0%，3684 枚椎弓根螺钉）。机器人辅助组的椎弓根螺钉精度明显优于 FH 技术（Gerztbein-Robbin 分级 A）（优势比[OR]：1.68，95%置信区间[CI]：1.20-2.35；p=.003）。同样，机器人辅助组的临床可接受椎弓根螺钉精度（A级+B 级）明显高于 FH 技术（OR：1.54，95%CI：1.01-2.37；p=.05）。此外，机器人辅助组的并发症发生率和近侧关节突关节侵犯率分别降低了 69%（OR：0.31，95%CI：0.20-0.48；p<.00001）和 92%（OR：0.08，95%CI：0.03-0.20；p<.00001）。与 FH 组相比，机器人辅助椎弓根螺钉植入术可显著减少术中放射时间（MD：-5.30，95%CI：-6.83-3.76；p<.00001）和放射剂量（MD：-3.70，95%CI：-4.80-2.60；p<.00001）。然而，与 FH 组相比，机器人辅助组的手术时间明显更长（MD：22.70，95%CI：6.57-38.83；p=.006）。
这项荟萃分析证实了机器人辅助椎弓根螺钉放置的准确性。
